12/01/2008 05:12 am ET Updated Nov 17, 2011

Accept No Substitutes (Part 1 of 3)

I constantly write: YOU DECIDE. Do not put your trust in Washington; in those seeking your vote (who will say or promise anything); in self-styled experts; or in me. You make the call: Is what they propose for healthcare good or bad?

This may appear to be a daunting task. Health care (the service) as well as healthcare (the system) are complex, confusing and highly dysfunctional. Cause and effect are widely separated in time. What we get is not what we want. What they measure is certainly not what we want. We do not take full responsibility for what we do to our bodies, and to our minds. Nonetheless, I ask, I implore you to decide for yourself. I can make it easier, not easy but easier.

My book Medical Malprocess was written to help you understand why healthcare is sick and what you can do about it. In that book, I offer a guide to assist you in evaluating any plan or proposal for healthcare. The guide is called a "Quorum of Questions and a Chant." In this and two subsequent blogposts, I will give you that guide - a standardized test that you can use to assess anything being proposed to fix healthcare.

The guide consists five questions that you answer and a chant you recite over and over. The first two are below. The rest will follow in future posts.

Question 1 (of 5)
Are they reconnecting me with my money?

If you do not know of Robert Heinlein, you are missing a great author who coined the word "Tanstaafl," meaning There is no such thing as a free lunch. When a person offers you something for free, beware! That person is naive, misinformed, outright lying, pandering for your vote, or all of the above. The free something will be very, very costly in the long run. Free universal health care is a new oxymoron, so "free" that it will consume our grandchildren's inheritance.

The only person who will control costs is the person who has to pay. That is me, you, and your next-door neighbor. Any effective Plan for healthcare must reconnect you with your money and me with mine. That translates to incentives (preferably positive) for: staying healthy; getting regular checkups and preventative care; and conserving resources.

If their Plan for healthcare does not do this, reject it. Accept no substitutes.

Question 2 (of 5)
Do they measure what we want?

You know what you want. It is the same thing that I want: living a long time; being healthy and functional; ready access to compassionate, high quality health care; quick and comfortable restoration of our health when we are sick; error-free medicine; costs that are commensurate with the benefits we receive; and better care tomorrow than is possible today.

What do they measure in healthcare? The system tracks: Deaths (failure to die is not the same as living long and well); Length of stay in hospital (as a surrogate for true costs); National healthcare expenditures with no corresponding measurement of benefits; Compliance with regulations as a surrogate for quality of outcomes; Complications and adverse impacts (but not recovery of function and productivity); and Lawsuits (see prior posts on medical malpractice). Compare this list to the list of what we all want in the previous paragraph, and keep in mind the old adage whatever you measure, that is what you get.

For any healthcare Plan to work, it must track the outcomes we want, not the ones we want to avoid. If the Plan being offered does not do this, reject it. The absence of pain is not the same as pleasure. The absence of death does not equal living long and well. Accept no substitutes.

To be continued.